no sperm on post coital?

aprilprincess

So I am doing follistim this cycle, everything looks great. I had two right size eggs and two more that looked like they could be good. My dr had me do a post coital test to see if I needed an IUI. He saw no sperm whatsoever. DH had 2 SAs (two different drs, I wasn't sure about the first dr) and passed both with flying colors. The dr said if my mucus was killing the sperm he'd see dead sperm. There wasn't a single one there. So we went ahead with the IUI last Saturday, but the dr couldn't come up with a reason for the no sperm thing.

I've been trying to find info online and can't find much, just that it means the post coital test is negative. This is also the second time I've had a post coital test show no sperm (which is why DH went to get checked in the first place). The first dr didn't say any reason other then check DH.

I'm hoping and praying with all my might that this time is it so we dont' have to go through it all again. But the great sperm mystery is intriguing me anyway.

JMay

I find this really interesting - if you ever get an answer as to why that might be, I'd love to know - update please, if you find out!

MaybeMore

No sperm is just fine.  It's a fairly common finding.

Post-coitals have limited predictive value--few people do them anymore.

Given that the sperm is great and there were no dead sperm in the post-coital, I'd say that IUI wouldn't help your chances.  Which is a good thing.  So if you're paying for it OOP, I wouldn't. 

aprilprincess

MaybeMore:

No sperm is just fine.  It's a fairly common finding. I keep hearing the opposite and can't find any info on it. I don't mean this in a snarky way at all, but where did you hear/find it was common.

Post-coitals have limited predictive value--few people do them anymore. That's what I had heard too, but 3/3 drs I've been to regarding fertility have done one or suggested it. I know our current RE said the findings are not accurate unless it's actually done on a monitored cycle close to ovulation, which might explain why it's not always predictive.

Given that the sperm is great and there were no dead sperm in the post-coital, I'd say that IUI wouldn't help your chances.  Which is a good thing.  So if you're paying for it OOP, I wouldn't.  What makes you say that? We are paying out of pocket (and like I said we did it last saturday, so it's done!) Our dr seemed to think the IUI was nescessary and he said he hadn't expected to need it at all based on how my cycle was going.

I'm not questioning your answers being right I'm curious about them since it's somewhat the opposite of what I'm finding.  Especially the 1st one since I can't find much at all about no sperm.

MaybeMore

I found it here, among other places:  https://www.amazon.com/Reproductive-Endocrinology-Infertility-Integrating-Laboratory/dp/1441914358/ref=sr_1_3?ie=UTF8&qid=1315616791&sr=8-3

>What makes you say that? We are paying out of pocket (and like I said we did it last saturday, so it's done!) Our dr seemed to think the IUI was nescessary and he said he hadn't expected to need it at all based on how my cycle was going.

If your husband's sperm is great and you have decent CM, there isn't any advantage that has been shown for IUI versus TI.  See the book above.  :-)  And there are lots of studies in PubMed about it.  IUIs are mostly effective for mild to moderate male factor.  As a group, people with other Dxs do not benefit.  For example, PCOS with no MFI shows bumpkiss for benefit of IUI over TI. 

MaybeMore

Oh, and there's a study showing the concentration of sperm in a post-coital has no statistical relationship with the number of sperm found in a followup uterine laparoscopy and that every post-coital that was negative for sperm with a man who was shown to have a good count had a positive laparoscopy result.  I didn't bookmark it though--it was while I was researching whether or not I should press the issue with the RE pending the results of the SA.

I think there should be an alternative to the post-coital--they should combine a sample of CM with the analyzed semen in vitro and then see what happens.  THAT would show clearly what kind of motility in the CM the semen will have.

aprilprincess

Thank you for letting me know all that! I'll look further into the book now. Sometimes I feel like it's harder to be an informed patient because you can find so much conflicting data. Luckily the RE I switched too is willing to discuss options and answer questions, my previous dr seemed to get annoyed if I tried to understand what was going on.